Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NUR-APRN-LIC-146464 | MT |
NPI | 1114576543 |
---|---|
Provider Name | Katrina Mae Smith |
First Address | Great Falls, MT 59405-5161 |
Second Address | Great Falls, MT 59405-5161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2019 |
Last Update Date | 19/09/2019 |